Gynae: Cervical pathology

Question 1

what is cervical ectropion?

Answer 1

aka cervical ectopy or cervical erosion

occurs when columnar epithelium of endocervix has extended out to the ectocervix

the lining becomes visible on examination of the cervix using a speculum - has a different appearance to the normal endocervix

Question 2

what hormone is cervical ectropion associated with?

Answer 2

higher oestrogen levels

more common in younger women, COCP and pregnancy

Question 3

what is the transformation zone?

Answer 3

border between the columnar epithelium of the endocervix and the stratified squamous epithelium of the ectocervix

transformation zone is located on ectocervix and is visible on speculum exam

Question 4

how does cervical ectropian present?

Answer 4

many asymptomatic - found incidentally during speculum or on smear tests

• increased vaginal discharge
• vaginal bleeding
• dyspareunia
• postcoital bleeding

Question 5

what will examination of the cervix show in cervical ectropian?

Answer 5

well-demarcated border between the redder, velvety columnar epithelium extending from the os and the pale pink squamous epithelium of the endocervix
border = tranformation zone

Question 6

is cervical ectropion associated with cervical cancer?

Answer 6

NO

Question 7

how is cervical ectropian managed?

Answer 7

• asymptomatic = no treatment
• typically resolve as pt gets old, stops pill or is no longer pregnant
• NOT contraindication for COCP
• problematic bleeding = indication for treatment with cauterisation of the ectropian using silver nitrate or cold coagulation during colposcopy

Question 8

what are nabothian cysts?

Answer 8

fluid-filled cysts often seen on the surface of the cervix

usually up to 1cm in size but rarely can be more extensive

harmless and unrelated to cervical cancer

Question 9

what is the pathophysiology of nabothian cysts?

Answer 9

columnar epitheloum of the endocervix produces cervical mucus. when squamous epithelium of the ectocervix slighlty covers mucus-secreting columnar epithelium, mucus becomes trapped and forms a cyst

can happen after childbirth, minor trauma, of cervicitis secondary to infection

Question 10

hoe to nabothian cysts present?

Answer 10

often found incidentally on speculum examination

do not usually cause any symptoms

when they are very large, they may cause a fullness in the pelvis

white/yellow appearance

Question 11

how are nabothian cysts managed?

Answer 11

women can be reassured no treatment is required

dont cause any harm and resolve spontaneously

any diagnostic uncertainty then woman can be referred for colposcopy to examine in detail

can be treated during colposcopy - excised or biopsied